title: Suggestion for a new grading scale for radiation induced pneumonitis based on radiological findings of computerized tomography: correlation with clinical and radiotherapeutic parameters in lung cancer patients.
abstract: BACKGROUND
  The objective of this research is the computed axial tomography (CT) imaging grading of radiation induced pneumonitis (RP) and its correlation with clinical and radiotherapeutic parameters.
  
  
  METHODS
  The chest CT films of 20 patients with non-small cell lung cancer who have undergone three- dimensional conformal radiation therapy were reviewed. The proposed CT grading of RP is supported on solely radiological diagnosis criteria and distinguishes five grades. The manifestation of RP was also correlated with any positive pre-existing chronic obstructive pulmonary disease (COPD) history, smoking history, the FEV1 value, and the dosimetric variable V20.
  
  
  RESULTS
  The CT grading of RP was as follows: 3 patients (15%) presented with ground glass opacity (grade 1), 9 patients (45%) were classified as grade 2, 7 patients (35%) presented with focal consolidation, with or without elements of fibrosis (grade 3), and only one patient (5%) presented with opacity with accompanying atelectasis and loss of pulmonary volume (grade 4). Both univariate and multivariate analysis revealed as prognostic factors for the radiological grading of RP the reduction of FEV1 and the V20 (P=0.026 and P=0.003, respectively). There was also a significant (P<0.001) correlation of radiological grading of RP with FEV1 and V20 (spearman rho 0.92 and 0.93, respectively).
  
  
  CONCLUSIONS
  The high correlation of the proposed radiological grading with the FEV1 and the V20 is giving a satisfactory clinical validity. Although the proposed grading scale seems relevant to clinical practice, further studies are needed for the confirmation of its validity and reliability.
authors.affiliation: 2nd Radiology Department, Medical School, Kapodistrian University of Athens, Athens, Greece. vkouloul@ece.ntua.gr
authors.forename: Vassilios
authors.initials: V
authors.lastname: Kouloulias
authors.forename: Anna
authors.initials: A
authors.lastname: Zygogianni
authors.forename: Efstathios
authors.initials: E
authors.lastname: Efstathopoulos
authors.forename: Oikonomopoulou
authors.initials: O
authors.lastname: Victoria
authors.forename: Antypas
authors.initials: A
authors.lastname: Christos
authors.forename: Karaiskos
authors.initials: K
authors.lastname: Pantelis
authors.forename: Vassilios
authors.initials: V
authors.lastname: Koutoulidis
authors.forename: John
authors.initials: J
authors.lastname: Kouvaris
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Sandilos
authors.forename: Maria
authors.initials: M
authors.lastname: Varela
authors.forename: Ilknur
authors.initials: I
authors.lastname: Aytas
authors.forename: Athanasios
authors.initials: A
authors.lastname: Gouliamos
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Kelekis
mesh_terms: D000368:Aged; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D005260:Female; D005355:Fibrosis / Q000150:complications; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D001261:Pulmonary Atelectasis / Q000150:complications; D017564:Radiation Pneumonitis / Q000145:classification* / Q000175:diagnosis / Q000000981:diagnostic imaging*; D012129:Respiratory Function Tests; D012907:Smoking; D014057:Tomography, X-Ray Computed